Supplementation of vitamin D in pregnant women with 25(OH) D deficiency and risk of preeclampsia development improves perinatal outcomes

Abstract

Hypertensive disorders in women during pregnancy account for about 14% of maternal deaths while preeclampsia / eclampsia can be avoided through preventive measures and the provision of timely and effective care for women with these complications. The aim. To determine the possibility of preventing preeclampsia by VD supplementation in a group of women with its insuffiency / deficiency and a high risk of developing this complication of pregnancy. Materials and methods.Randomized controlled clinical trial was carried out in 2017-2020, the annual number of deliveries is 2200-2400. All the subjects (n=54) gave informed consent to participate in the examination and processing of their personal data. Selection criteria: 1st trimester, presence of 25 (OH) D3 deficiency and risk factors for PE. In the 1st group (n = 25) women received a multivitamin-mineral complex (MVMC) (including colecalciferol 500 IU), in the 2nd (n = 29) colecalciferol was additionally prescribed at a dose of 4000 IU until the completion of structural formation placenta (16 weeks of pregnancy), then 2.000 units until the end of pregnancy. The level (25 (OH) D) in the blood was determined by ELISA. Results. The groups were homogeneous in terms of age, anthropometric data, birth parity, general somatic and reproductive history. VD supplementation led to its significant increase by the 3rd trimester in the 2nd group (2 8.7 ± 5.9 ng / ml and 38.3 ± 7.1 ng / ml; Uemp = 146; p <0.01), in contrast to the 1st (26.08 ± 7.5 ng / ml and 28.9 ± 6.9 ng / ml; Uemp = 284; p> 0.05). In the 1st group (24% VS 6.9%) PE developed 3.5 times more often (F = 0.0014; p <0.01; OR = 3.27; 95% CI 1.018 - 10.524); preterm birth was observed 2 times more often (36% VS 17.2%; F = 0.0037; p <0.01; OR = 2.74; 95% CI 1.416 - 5.327), cesarean section - 1.7 times (48% VS 27.6%; F = 0.0055; p <0.05; OR = 2.374; 95% CI 1.320 - 4.369) and intrauterine growth retardation - 4.5 times more often (16% VS 3.5%; OR = 4.571; 95 % CI 1.471 - 14.210). Conclusions. Supplementation of colecalciferol to the vitamin and mineral complex throughout pregnancy is accompanied by a significant improvement in perinatal outcomes, including a lower incidence of preeclampsia, premature birth, fetal growth retardation and cesarean sections. Further research is needed to obtain convincing data with a reliable evidence base and substantiate the need to assess and correct vitamin D status in women at the stage of preconception preparation. All human studies were conducted in compliance with the rules of the Helsinki Declaration of the World Medical Association "Ethical principles of medical research with human participation as an object of study". Informed consent was obtained from all participants.